Would you compromise target coverage to meet OAR constraints for prostate radiation?

For example, reducing coverage to 95% of Rx within a large median lobe for an intermediate risk prostate cancer case with no gross disease near base that is not meeting multiple bladder planning objectives?

Answer from: Radiation Oncologist at Academic Institution

Median lobes can sometimes be challenging. There are a few options in this scenario. First, and most simply, ensure your bladder is comfortably full for simulation. Most IMRT bladder constraints are volumetric, so larger bladder sizes make meeting constraints easier. Second, if the median lo...

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Radiation Oncologist at Mayo Clinic
Our group has used all of the techniques outlined ...

Answer from: Radiation Oncologist at Community Practice

Generally, no, I'd treat as planned. I treat at 725 cGy/fx for 5 fx. The bladder constraints I use are D10% <18.1 Gy and D0.03cc <38.1 Gy. It's not unusual to not meet the 10% criteria in patients with large and/or irregular prostates. I have not, as yet, seen bladder damage or late effect dys...

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Would you compromise target coverage to meet OAR constraints for prostate radiation?

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